Comprehensive Clinical Characterization of Patients Diagnosed With Dilated Cardiomyopathy: A Cross-Sectional Study

Background The term "cardiomyopathy" encompasses a wide range of diseases with various underlying causes. Dilated cardiomyopathy (DCM) is characterized by ventricular dilation and impaired cardiac function in the absence of congenital, valvular, hypertensive, or ischemic heart disease (IHD). This study was motivated by the high prevalence of underlying DCM and chronic heart failure, coupled with a lack of comprehensive information on DCM. The primary objective of this study was to identify the clinical characteristics and contributing factors associated with individuals diagnosed with DCM. Methods A total of 120 patients with DCM were enrolled in a two-year, hospital-based observational cross-sectional study conducted within the Medicine Department of a tertiary care center. The study assessed risk factors, including IHD, diabetes mellitus, alcohol consumption, and smoking. Results DCM was observed across all age groups, though it was notably more prevalent among middle-aged individuals (n = 50, or 41.7%) and the elderly (n = 35, or 37.5%). The condition was more commonly seen in men. IHD emerged as the predominant risk factor, affecting 75% of patients (n = 90), followed by diabetes mellitus (n = 85, or 70.8%), alcohol use (n = 75, or 62.5%), and smoking (n = 50, or 41.7%). Common symptoms included pedal edema, palpitations, easy fatigability, and exertional dyspnea. Conclusion In conclusion, DCM is a critical condition that necessitates vigilant monitoring. Consistent observation of symptoms, recognition of potential triggers, and prompt identification of adverse drug reactions, electrolyte disturbances, and echocardiographic changes are essential. This awareness and early detection were responsible for the lower mortality and early symptom improvement observed in the present study group.


Introduction
Cardiomyopathies encompass a range of heart diseases that lead to structural and functional abnormalities in the heart muscle.This category includes hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and spongy heart muscle disease, many of which have genetic origins.Despite their varied causes, cardiomyopathies frequently result in heart failure due to issues with systolic or diastolic function.DCM, in particular, is characterized by the enlargement and impaired function of the ventricles, occurring without the presence of high blood pressure, valve disorders, congenital abnormalities, or coronary artery disease.
The estimated prevalence of DCM ranges from five to eight cases per 100,000 people, though these figures may underestimate the actual rates due to underreporting or undiagnosed asymptomatic cases.The clinical characteristics and progression of idiopathic DCM in adults are well-documented in the literature [1][2][3][4][5].In 1980, cardiomyopathies were classified into DCM, HCM, restrictive cardiomyopathy, ARVC, and unclassified types [6,7].In 1996, the World Health Organization, the International Society, and the Federation of Cardiology updated this classification to distinguish viral and inflammatory cardiomyopathies as separate categories [8][9][10].
Diagnostic criteria for DCM include a left ventricular end-diastolic size exceeding 112% of the predicted value, adjusted for age and body size, as measured by two-dimensional echocardiography.Additionally, a left ventricular ejection fraction (LVEF) below 0.45 and/or fractional shortening under 25% are critical indicators.These criteria are based on research by Henry et al. [11].The objective of this study was to describe the clinical profile and identify risk factors in patients diagnosed with DCM.

Selection criteria
All patients who met the echocardiographic criteria and presented with symptoms indicative of DCM were included in this study.Individuals with systemic hypertension, coronary artery disease, congenital heart disease, or valvular heart disease were excluded.

Data sources and variables
Heart failure signs and symptoms were evaluated as part of the clinical examination.Symptoms assessed included dyspnea, palpitations, orthopnea, pedal edema, chest discomfort, cough, and easy fatigability, among others.Physical examination signs included pedal edema, hepatomegaly, elevated jugular venous pressure (JVP), basal crepitations, and heart murmurs.Baseline blood examinations were conducted by the Department of Pathology and the Department of Biochemistry.Additionally, echocardiography, electrocardiogram, and chest X-rays were performed.

Statistical analysis
Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) was used to enter the data into a master file, and IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, NY, USA) was used for analysis.Categorical and continuous variables were described using descriptive statistics, including mean, percentage, and frequency analyses.Statistical data are presented as mean ± standard deviation (SD).

TABLE 3: Allocation of patients based on contributing factors and comorbid conditions
Table 4 presents the echocardiographic findings in patients.The mean LVEF was 34.5%, with an SD of 6.1, and the values ranged from 20.0% to 48.0%.The average end-diastolic diameter was 5.8 cm with an SD of 1.2, and the range spanned from 4.0 cm to 7.0 cm.The mean end-systolic diameter was 4.6 cm with an SD of 1.1, and the measurements ranged from 3.5 cm to 5.9 cm.

Discussion
In this study, the demographic data show that the patient population comprised 62.5% males and 37.5% females.This finding is consistent with previous studies, such as those by Teple and Kalra [12] and Dudharejia and MNandania [13], which also reported a predominance of males among patients with similar conditions.However, Kumar et al. [14] found a slightly different male-to-female ratio, reflecting variability that might be attributed to different sample populations or regional differences.The age distribution in the present study indicates that 12.5% (n = 15) of patients were aged 20-39 years, 41.7% (n = 50) were 40-59 years, 37.5% (n = 45) were 60-79 years, and 8.3% (n = 10) were 80 years or older.This distribution reveals a significant proportion of middle-aged and older patients, similar to the findings of Kumar et al. [14] and Dudharejia and MNandania [13].The mean age of 58 years, with an SD of 13, highlights the condition's prevalence in older adults, consistent with age ranges reported in other studies.
Regarding NYHA classification, the study found that 50% (n = 60) of patients were in Class II, while 33.3% (n = 40) were in Class III.These findings suggest a predominance of moderate to severe symptoms among the study population.This distribution differs somewhat from Kumar et al. [14], who reported a higher percentage of patients in Class I.The variation might be due to differences in disease severity or stage at presentation.The symptom profile revealed that dyspnea was universally observed, with fatigue, palpitations, and pedal edema being the next most common symptoms.This symptom distribution aligns with the findings of Teple and Kalra [12] and Dudharejia and MNandania [13], who also identified dyspnea and fatigue as predominant symptoms.The high prevalence of dyspnea and fatigue underscores the debilitating nature of the condition, while the presence of pedal edema and palpitations highlights the importance of evaluating a range of symptoms in managing patients.
In terms of physical examination findings, basal crackles, abnormal heart sounds, and elevated JVP were observed in significant proportions of the study population.These findings are consistent with those reported by Dudharejia and MNandania [13], indicating advanced cardiac involvement, which aligns with the NYHA classification and symptom severity observed in this study.Echocardiographic measures showed a mean LVEF of 34.5% and significant dilation of the left ventricle, with mean end-diastolic and end-systolic diameters of 5.8 cm and 4.6 cm, respectively.These values reflect severe cardiac dysfunction, consistent with reports by Teple and Kalra [12].The reduced LVEF and increased ventricular diameters highlight the severity of cardiac impairment in this patient population and underscore the need for effective management strategies.
At discharge, 80% (n = 95) of patients showed improvement, indicating the effectiveness of the treatment regimen, which included beta-blockers, ACE inhibitors, diuretics, anticoagulants, and digoxin.However, the 20% (n = 25) mortality rate reflects the severe nature of the condition and the challenges in managing advanced cases.This outcome emphasizes the importance of early diagnosis and comprehensive management to improve patient outcomes.Similar outcomes have been observed in the study by Mishra et al. [15], which reports comparable findings regarding patient demographics, symptom profiles, and echocardiographic measures.Overall, the present study offers significant insights into the demographic, clinical, and echocardiographic characteristics of patients with this condition.The results align with existing literature but also highlight areas of variability that warrant further investigation.The high proportion of patients showing improvement underscores the effectiveness of current treatment strategies, though the mortality rate highlights the need for ongoing research and optimization of management protocols.

Limitations of the study
Despite the valuable insights provided, several limitations should be acknowledged.The cross-sectional design of the study limits conclusions about causation and disease progression.While the sample size of 120 individuals is substantial, it may not fully represent the broader patient population, potentially affecting the generalizability of the results.The study's reliance on clinical and echocardiographic data might not capture all aspects of disease severity and progression, as it excludes other diagnostic modalities, such as advanced imaging or biomarkers.Furthermore, the high mortality rate observed may reflect the advanced stage of the disease in the patient population studied, which could influence the overall assessment of treatment efficacy.

Conclusions
The observations indicate that DCM is a serious condition that requires thorough monitoring.Regular and attentive observation of symptoms, vigilance for signs of vital organ dysfunction, awareness of potential symptom exacerbators, and early identification of adverse drug effects, electrolyte imbalances, and echocardiographic changes in the morphology and function of the left ventricle are crucial.The decreased mortality rate in the present study group and the early relief of symptoms can be attributed to the prompt detection and management of these factors.
relationships or activities that could appear to have influenced the submitted work.
This two-year observational cross-sectional study was conducted in the Department of Medicine.Patients diagnosed with DCM were admitted through the ICU, Emergency Department, Medical Outpatient Department (OPD), or Medical Ward.The research protocol adhered to the hospital's approved ethical guidelines, as established by the Institutional Ethics Committee of MediCiti Institute of Medical Sciences (IEC-MIMS-2024-001).

TABLE 1 : Demographic distribution of participants
n: Number of patients; SD: Standard deviation

TABLE 2 : Allocation of patients according to their signs and symptoms, as well as their NYHA functional classification grade
NYHA: New York Heart Association; JVP: Jugular venous pulse; PND: Paroxysmal nocturnal dyspnea

TABLE 4 : Echocardiographic findings in patients
SD: Standard deviation

Table 5
shows the outcome of patients at discharge.Among the 120 patients, 80% (95 patients) showed improvement, while 20% (25 patients) expired.Eighty percent of patients experienced significant improvement and were discharged due to the careful and appropriate use of beta blockers, angiotensinconverting enzyme inhibitors, diuretics, blood thinners, digitalis, and other supportive treatments as needed.